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European Heart Journal Advance Access originally published online on January 5, 2007
European Heart Journal 2007 28(11):1366-1373; doi:10.1093/eurheartj/ehl456
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Myocardial positive pre-ejection velocity accurately detects presence of viable myocardium, predicts recovery of left ventricular function and bears a prognostic value after surgical revascularization

Martin Penicka1, Petr Tousek1, Bernard De Bruyne2, William Wijns2, Otto Lang3, Juraj Madaric2, Marc Vanderheyden2, Jaroslav Tintera4, Marek Maly5, Petr Widimsky1 and Jozef Bartunek2,*

1 From the Cardiocenter, Department of Cardiology, 3rd Medical School Charles University and University Hospital Kralovske Vinohrady Srobarova 50, 100 34 Prague, Czech Republic
2 Cardiovascular Center, OLV Hospital, Aalst, Belgium
3 Department of Nuclear Medicine (O.L.), 3rd Medical School Charles University and University Hospital Kralovske Vinohrady Prague, Czech Republic
4 Department of Radiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
5 Department of Biostatistics and Informatics, National Institute of Public Health, Prague, Czech Republic

Received 2 April 2006; revised 9 November 2006; accepted 7 December 2006; online publish-ahead-of-print 5 January 2007.

* Corresponding author. Tel: +32 53 72 4447; fax: +32 53 72 4550. E-mail address: jozef.bartunek{at}olvz-aalst.be

Aims: To assess the accuracy of tissue Doppler imaging-derived myocardial positive pre-ejection velocity (+Vic) in detecting myocardial viability defined by dobutamine stress echocardiography (DSE), fluorine-18 fluorodeoxyglucose positron emission tomography (PET), and contrast-enhanced magnetic resonance imaging (MRI), and in predicting recovery of left ventricular (LV) function after coronary artery bypass grafting (CABG) in patients with chronic ischaemic LV dysfunction.

Methods and results: +Vic in dysfunctional segments was recorded in 54 patients treated medically and 65 patients undergoing CABG [age 67 ± 9 year; LV ejection fraction (EF) 30 ± 6%]. A good agreement was observed between +Vic and detection of viable myocardium at DSE, PET, and MRI (kappa = 0.76). The presence of +Vic in greater than or equal to five dysfunctional segments had the highest sensitivity (93%) and specificity (60%) to identify patients (n = 28) with ≥10% increase in LV EF between baseline and 6-month echocardiogram. During follow-up (median 333 days, interquartile range 209–490 days), 13 cardiac events (6 deaths, 7 hospitalizations) occurred in 24 patients with small extent of viable myocardium (< 5 + Vic), whereas only four hospitalizations in 39 patients with ≥5 + Vic (54% vs. 10%; P < 0.001).

Conclusion: The extent of +Vic in dysfunctional segments accurately predicts extent of viable myocardium and bears a clinical prognostic value in patients with ischaemic LV dysfunction considered for CABG.

Key Words: Tissue Doppler imaging • Viability • Coronary disease • Echocardiography • Bypass


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